1. Field of the Invention
The present invention relates to an apparatus and method for positioning surgical elements adjacent to body tissue. More particularly, this invention relates to an apparatus for winding surgical elements within an endoscopic tube for later positioning adjacent to herniated body tissue.
2. Description of the Related Art
Hernias are abnormal protrusions of an organ or other body structure through a defect or natural opening in a covering membrane, muscle or bone. An inguinal hernia is a protrusion which makes its way through the abdomen in the inguinal (groin) region. Hernias may be divided into three general classes: direct inguinal hernia, indirect inguinal hernia and femoral hernia. In both direct and indirect inguinal hernias, a part of the intestine may protrude through a defect (opening or tear) in the supporting abdominal wall to form a hernial sac. In a femoral hernia, a portion of the intestine is forced through the femoral ring into the femoral canal forming a hernial sac.
Traditional hernia repair surgery involves major invasive surgical procedures which often cause excessive trauma to the patient and necessitate long post-operative recuperative periods. The surgery typically requires an incision in the groin ranging up to six inches in length. Several layers of the abdominal wall are generally separated to reach the herniated portions. During the procedure, the opening or tear in the abdominal wall is closed in a manner which resembles the tying of a sack at the neck. Often a surgical mesh is attached by sutures directly over the repaired hernia opening to provide a reinforcement to the opening. In addition, numerous complications related directly or indirectly to the surgery often result including bleeding, infection, testicular atrophy, organ damage, nerve damage, blood vessel damage, etc. A detailed discussion of traditional hernia repair may be found in "Hernia Repair Without Disability, Second Edition", by Irving L. Lichtenstein. Such invasive surgical procedures are also utilized in other areas of the body, including surgery on the gall bladder, appendix, lungs and the like.
To avoid many of the previously stated risks and problems, the use of laparoscopic and endoscopic surgical procedures have become relatively popular and have provided additional incentive to develop the procedures further. In laparoscopic procedures, surgery is performed in the interior of the abdomen through small tubes inserted therein. Similarly, in endoscopic procedures, surgery is performed in any hollow viscus of the body through narrow endoscopic tubes inserted through small entrance wounds in the skin.
Laparoscopic and endoscopic procedures generally require that the surgical region be insufflated. Accordingly, any instrumentation inserted into the body should be substantially sealed to ensure that gases do not enter or exit the body through the incision. Moreover, laparoscopic and endoscopic procedures often require the surgeon to operate on organs, tissues and/or vessels far removed from the incision. Thus, instruments used in such procedures are typically long and narrow while being functionally controllable from a proximal end of the instrument.
In hernia surgery, as compared to gall bladder surgery, certain procedures and instruments are the same, and certain instrument requirements differ. For example, in hernia surgery a suitable mesh material is generally sutured over the opening in the tissue. Often, the mesh material is attached by sutures and left within the body to act as a reinforcing agent for tissue regrowth in the area of the surgery. One example of a mesh material currently utilized in hernia surgery includes a polypropylene material marketed by C. R. Bard, under the trademark MARLEX. Another example of a mesh material is a tri-fluoroethylene material marketed by W. L. Gore & Associates, Newark, Del., under the trademark GORE-TEX.
As noted, during conventional invasive surgical procedures, such mesh materials are manually placed over the defect in the abdominal wall and are often sutured within the surgical opening by conventional suturing techniques. However, with the advent of laparoscopic surgery the need for suitable mesh, mesh positioning and mesh attachment techniques through the relatively narrow tubes or cannulas is clearly defined.
Heretofore, resilient type mesh deploying apparatus have been provided which deploy a surgical implant from an endoscopic tube. An example of this type of mesh deployer is illustrated in Surgical Laparoscopy & Endoscopy, Vol. 1, No. 3, pgs. 151-153, which discloses an Endo-patch Spreader manufactured by Nanticoke Surgical Instruments Inc., Seaford, Del. However, such deploying apparatus are deployed by releasably securing the mesh to a spreader and simply disengaging the mesh from the spreader without further interaction between the mesh and the spreader. Thus, if a surgeon wants to further manipulate the mesh another instrument, such as a grasper, must be inserted into the surgical region.
Therefore, there remains a need for an apparatus which facilitates endoscopic deployment of surgical elements adjacent to body tissue within body cavities. Furthermore, there remains a need for facilitating endoscopic positioning of surgical implants adjacent to body tissue for subsequent securement thereto by means of sutures, clips, staples or the like.